Application/renewal For Notary Public - South Carolina Secretary Of State Page 2
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1
2Application/Renewal for Notary Public
For delegation office
use only
S
S
C
TATE OF
OUTH
AROLINA
O
S
S
__________________
FFICE OF THE
ECRETARY OF
TATE
Date received
T
H
M
H
HE
ONORABLE
ARK
AMMOND
New _______ Renew_______
To: Governor of the State of South Carolina
I respectfully petition to be appointed Notary Public for this State, and for your information, I herewith submit the following:
Name ______________________________________________________________________________________________________
Mailing Address __________________________________ City ________________________ Zip Code ______________________
Home Street Address ____________________________________City ________________________ Zip Code _________________
County _______________________ Social Security # __________________________ Sex ______ Date of Birth _______________
Voter Registration # __________________________
(Voter Registration Number may be obtained from your County Registration and Election Office or Voter Registration Office)
(____)______________________
Telephone #
E-mail__________________________________________________________
Languages other than English in which fluent ______________________________________________________________________
OATH OF NOTARY PUBLIC
I do solemnly swear (or affirm) that I am duly qualified, according to the Constitution of South Carolina, to exercise the duties of the
office to which I have been appointed and that I will, to the best of my ability, discharge the duties thereof and preserve, protect and
defend the Constitution of this State, and of the United States. So help me God.
Sworn to and subscribed before me
___________________________________________
This _________ day of _________________, 20___________
Signature of applicant
Date________________________________ _______
__________________________________________________
Notary Public of South Carolina
My Commission Expires _____________________________
Mail application to delegation for required signatures (addresses and telephone numbers are on back of application).
This section should be completed by the Legislative Delegation. Please choose one of the three options.
We, the _______________________________________Delegation, recommend the appointment of the above named applicant.
(
County)
1)
2)
________________________________________________
____________________________________________________
Signature of the Delegation Chairman OR Secretary
Signature of Senator / Senate District #__________________
_____________________________________________________
Signature of House Member / House District # ______________
3) Signed by at least half of the present Legislative Delegates from applicant’s county of residence:
________________________________________
_________________________________________
________________________________________
_________________________________________
________________________________________
_________________________________________
________________________________________________
_________________________________________________
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